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Critical Medical Anthropology Annals of Agricultural and Environmental Medicine 2015, Vol 22, No 2, 385–389 REVIEW ARTICLE www.aaem.pl Critical Medical Anthropology – a voice for just and equitable healthcare Anna Witeska-Młynarczyk1 1 Institute of Ethnology and Cultural Anthropology, Adam Mickiewicz University, Poznan, Poland Witeska-Młynarczyk A. Critical Medical Anthropology – a voice for just and equitable healthcare. Ann Agric Environ Med. 2015; 22(2): 385–389. doi: 10.5604/12321966.1152099 Abstract The article presents a paradigm current in contemporary medical anthropology – Critical Medical Anthropology (CMA), which merges political-economic approaches with a culturally sensitive analysis of human behaviour grounded in anthropological methods. It is characterized by a strongly applied orientation and a devotion to improving population health and promoting health equity. The beginning of CMA dates back to the 1970s when the interdisciplinary movement called the political economy of health was developed. Today, CMA has grown into one of three major perspectives used in anthropological research devoted to health, illness and wellbeing. The author discusses the origins, key concepts and CMA’s usefulness for social research, and its significance for the design of effective policies in the realm of public health. Examplary interventions and ethnographic researches are introduced and wider usage is advocated of such works and methods by bureaucrats and medical staff for understanding the patients’ behavior, and the influence of social, economic and political factors on the workings of particular health systems. Key words medical anthropology, evidence-based medicine, social justice, cultural diversity INTRODUCTION Anthropology (CMA) – the paradigm which merges political- economic approaches with culturally sensitive analysis of Medical anthropology advances an interdisciplinary research human behavior grounded in anthropological methods [2]. agenda on contemporary practices related to health, sickness This article presents in a very concise manner the origins and healing, based on ethnographic fieldwork, bringing of CMA, the theoretical and conceptual framework and into focus the social roots of disease and wellbeing. Medical some of the examples of the ethnographic work conducted anthropologists derive inspiration from general social theory, within this paradigm. It can be read as an anthropological as well as, they use inisghts from other sciences such as appendix to the text by Włodzimierz Piątkowski and Michał medicine, psychology, epidemiology or demography. Skrzypek which appeared in an earlier issue of the AAEM, Called a ‘sister discipline’ of sociology, with which it shares titled To tell the truth. A critical trend in medical sociology – major theoretical premises, medical anthropology remains an introduction to the problems [4]. consistent and distinct in its usage of qualitative methodology Works rooted in the CMA perspective constitute a strong with a preference given to long-term participant observation and valuable voice for the humanization of contemporary [1]. However, it is difficult to draw exact disciplinary practices related to health, sickness and the body, which borderlines in current anthropological research focused on the mentioned authors seem to advocate. The critical health, sickeness and healing. anthropologists allow real people to speak extensively about The field of medical anthropology has been developing since the politicalized medical realities of their everyday lives. the 1970s. From its inception, it had an applied orientation These experiences and narratives often remain hidden, i.e. anthropologists were strongly engaged in projects aimed as in the case of the Polish women who use Assisted at improving population health and promoting health equity Reproductive Technology (ART) to become mothers [5]. [2]. Moreover, the emergent approach was characterized by Critical ethnographic insights bring people’s stories to a critical take on biomedical knowledge and practice. By light, in particular the stories of those living at the social biomedicine – also known as scientific medicine or evidence- marigins, and return to them their proper worth. With this, based medicine – anthropologists understand a historically article in turn, I wish to advocate CMA, which is known developed system of knowledge and social practice focused only by narrow circles of professionals. I believe the critical on scientific way of identifying disease and its etiology, as well medical anthropologists can provide unique insights into the as being devoted to the development of a universal system discussion concerned with making medicine more humane. of diagnosing and healing. Medical anthropologists work within a few theoretical orientations. As classified by Ann Critical Medical Anthropology – origins and influences. McElroy and Patricia Townsend [3], these include: ecological The critical perspective fostered by medical anthropologists theories, interpretive theories, political economy or critical shall be considered a part of a larger interdisciplinary theories (i.e. CMA), and political ecological theories. One movement known as the political economy of health. It of the most potent perspectives today is Critical Medical has been diluted within such disciplines as: sociology, geography, public health, epidemiology, economics or Address for correspondence: Anna Witeska-Młynarczyk, Adam Mickiewicz environmental studies. Sal Restivo states that the political University, Institute of Ethnology and Cultural Anthropology, ul. Św. Marcin 78, 61-809 Poznań, Poland, http://etnologia.amu.edu.pl economy of health E-mail: [email protected] is a theoretical framework used to study health inequalities. Received: 06 November 2013; accepted: 28 March 2014 It proposes that health disparities are determined by 386 Annals of Agricultural and Environmental Medicine 2015, Vol 22, No 2 Anna Witeska-Młynarczyk. Critical Medical Anthropology – a voice for just and equitable healthcare social structure and institutions that create, enforce, and wellbeing are recognized by engaged anthropologists as the perpetuate poverty and privilege. […] [Political economists most serious contemporary global challenge. of health – AWM] analyze the relationships between health In the 1980s, with the advancements in poststructuralist status and political-economic institutions throughout the thought, the concept of biopower authored by Michel Foucault world, with particular emphasis on the detrimental health [12] became popular among social scientists. Biopower refers effects created by capitalist relations of production and to a new form of social control which emerged within the sustained by specific political-economic arrangements [6]. context of a modern nation-state. This kind of control based on specific modern regimes of knowledge and practice – The critical approach to health and illness is rooted in the e.g. hospital, public health or population measurement Marxist tradition. Friedrich Engels’ book The Condition of techniques – is not achieved through coercion but through the Working Class in England [7] constitutes the classic of dissemination of knowledge in an institutionalized form, for critical analysis of disease understood as socially conditioned example, in schools. Such knowledge appears natural and and dependent on power and class relations. Another normal to people and becomes the basis for their behaviours, early intellectual influence was the German pathologist- choice-making and self-perceptions. With reference to the anthropologist Rudolf Virchow (1821–1902), who gained human body and health, it implies internalizing various fame with his socially-sensitive study of a typhus epidemic body techniques (such as diet, sexual behaviour or drug that broke out in Upper Silesia in 1848. intake) and cognitive schemata (such as the tendency to make The beginning of critical perspective in medical oneself responsible for ill health as opposed to, for example, anthropology dates back to 1973 and the symposium Topias recognizing the social determinants of illness). and Utopias in Health organized for the Ninth International More recently, CMA has also been increasingly sensitive Congress for Anthropological and Ethnological Sciences. to phenomenological thought moving away from the pure Important later developments were: Soheir Morsy’s ‘The Foucauldian mode of presenting patients as docile bodies, Missing Link in Medical Anthropology: the Political and penetrating the subjective dimension of health and Economy of Health’ [8], published in Reviews in Anthropology, sickness, treating patients as furnished with agency [13]. and Hans Baer’s essay ‘On the Political Economy of Health’ These developments coincide with the growing interest of the published in the Medical Anthropology Newsletter [9]. These social sciences in the body as a significant component of the essays constituted an overview of the field of the political contemporary culture and mode of self-construction [14]. economy of health and aimed for the inclusion of its program Eventually, contemporary critical thought tries to merge into the anthropological agenda [10]. Anthropologists’ both structural and individual levels of analysis. It focuses warming up with the political economy of health shall be on the interaction between individual agency and social understood as a part of a larger process. The 1970s in the processes of which institutional and discursive power is a United States were marked by a general
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